Sponsored by:
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
Senator RENEE C. BURGESS
District 28 (Essex)
SYNOPSIS
Requires DOH to establish three-year Obstetric Discrimination Prevention and Mitigation Pilot Program.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the prevention of obstetric discrimination and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. The Legislature finds and declares that:
a. Every person should be entitled to dignity, safety, and respect during and after pregnancy and childbirth, and every patient should receive the best possible and most equitable health care regardless of age, race, ethnicity, religion, ancestry, disability, sex, gender identity, gender expression, sexual orientation, or socioeconomic status.
b. The United States has the highest maternal mortality rate in the developed world. According to a report from the National Center for Health Statistics, in 2021, 1,250 women died of maternal causes, a rate that was compounded by the coronavirus disease 2019 (COVID-19) pandemic.
c. The report also noted significant racial inequities in the nations maternal death rate. From 2018 to 2021, the maternal death rate increased across all racial groups, with the largest rise disproportionately affecting Black mothers. For example, in 2021, the rate for Black women was 69.9 deaths per 100,000 live births, which is 2.6 times the rate for White women, at 26.6 per 100,000.
d. While the federal Centers for Disease Control and Prevention (CDC) finds that the majority of pregnancy-related deaths are preventable, maternal death rates have been either stable or rising across the United States. Factors including high rates of cesarean sections, inadequate prenatal care, high rates of pregnancy and childbirth among older women, lack of health insurance covering the period beyond six weeks postpartum, elevated rates of chronic illnesses prior to pregnancy, like obesity and diabetes, pregnancy-related hemorrhage disorders, and pregnancy-related hypertension disorders may be contributing to the high maternal morbidity and mortality rate in the United States.
e. These factors, however, do not fully explain the disparity seen in the maternal mortality and morbidity rates disproportionately impacting Black birthing communities.
f. In 2022, the CDC released findings from an analysis of 1,018 pregnancy-related deaths in the United States from 2017 to 2021. The analysis found that 84 percent of deaths across 36 states were preventable, 53 percent occurred between seven days and one year after childbirth, and although Black women make up approximately 13 percent of total population of women in the United States, nearly one in three persons who died identified as non-Hispanic black.
g. The CDC analysis demonstrated the ongoing failures of the countrys health care systems to keep Black women safe throughout pregnancy, childbirth, and the first year postpartum. The analysis further reinforced the fact that the primary drivers of preventable harm and death are variations in quality and patient safety in hospitals in the United States and the absence of meaningful accountability measures.
h. In spite of an emphasis on patient safety measures and continuous quality improvement strategies, there is a growing body of evidence that discrimination, specifically obstetric discrimination, is a key driver of variations in the quality of perinatal care patient safety in maternity care hospitals, resulting in unfair and preventable pregnancy-related deaths and disproportionate impacts on the lives, livelihoods, and reproductive, perinatal, and mental health of Black mothers
i. Perinatal quality improvement tools, used to evaluate quality of care and patient safety and improve preventable perinatal morbidity and mortality, tend to focus on clinical outcomes and the disparate rates of adverse pregnancy-related outcomes between Black mothers and non-Black birthing communities, namely, differences in outcomes whereby race, and not obstetric discrimination, is the risk factor.
j. Perinatal quality improvement tools that focus on clinical outcomes and measure the differences in adverse pregnancy-related outcomes between Black mothers and non-Black birthing communities in terms of race, not discrimination, create a false narrative of quality, value, and patient safety in hospitals.
k. These types outcome measurements also fail to capture hospital performance based on how well or how poorly hospitals see, hear, believe, support, and celebrate Black mothers during the provision of care during and after pregnancy and childbirth.
l. Perinatal quality improvement tools based on clinical outcome measurements do not address the systemic exclusion and erasure of Black patient experiences and community wisdom in shaping terminology, measurement selection, and monitoring strategies, silencing Black patient voices and undermines the agency and self-efficacy of Black mothers in telling their stories and having others see, hear, and believe them when making health care decisions during and after pregnancy and childbirth.
m. As a result, perinatal quality improvement tools do not recognize obstetric discrimination as an adverse event that violates the quality of care provided to, and safety of, Black mothers during childbirth hospitalizations.
n. Further, current perinatal quality improvement tools do not take into account how obstetric discrimination, perpetrated by health care professional and other hospital staff, creates and facilitates physical, emotional, and socio-cultural harm, violating the quality of care provided to, and safety of Black mothers.
o. Perinatal quality improvement tools and patient safety programs that do not address obstetric discrimination create mistruths that cause data specialists, quality control and patient safety professionals, and insurance companies to conflate the absence of perinatal complications or pathology as evidence of perinatal quality, safety, and equity. For example, a hospitals high rate of Black vaginal births does not necessarily mean that the hospitals staff is routinely present, engaged, and responsive to needs of Black mothers during childbirth hospitalizations.
p. The authors of an article published in the British Medical Journal Quality and Safety Journal, entitled Emotional safety is patient safety, justify the need for a new patient safety paradigm to bridge the gap between feeling safe as defined by patient experiences and being safe as defined by traditional quality control and patient safety professionals, using obstetric discrimination as an exemplar.
q. Obstetric discrimination leads to adverse events that violate patient safety and the quality of care provided to a patient during a childbirth hospitalization. These adverse events during a childbirth hospitalization lead to anti-Black, racialized perinatal health inequities and maternal morbidity and mortality that disproportionately impact Black mothers.
r. Without addressing the presence, perpetuation, and impact of obstetric discrimination as an adverse event during childbirth hospitalizations for Black mothers, the use of current perinatal quality improvement tools create barriers to developing and implementing research-based action plans that can be adapted to measure, monitor, report, prevent, or mitigate language used and behaviors enshrined in existing hospital policies, procedures, and programs.
s. The use of a valid perinatal quality improvement tool that takes into account obstetric discrimination as a critical driver of health inequities can assist policy makers and health care professionals in making measurable and meaningful improvements in perinatal health care and reproductive and perinatal health care experiences and outcomes for Black mothers.